中药治疗肝肾阴虚证绝经后骨质疏松的Meta分析

目的系统评价中成药和汤剂治疗肝肾阴虚证绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)的疗效及安全性。方法计算机检索CNKI、CBM、VIP、万方数据库、PubMed、Embase、Cochrane图书馆,检索自建库以来至2019年9月23日的文献,按照纳排标准,收集调补肝肾法治疗PMOP的临床对照试验,依据Cochrane Handbook for Systematic Reviews of Interventions(version 5.35)进行质量评估,并使用RevMan5.3软件进行Meta分析。结果纳入9篇文献,9个研究。与常规治疗的中成药和西药相比,在降低中医证候积分分别为MD=-3.74,95%CI(-4.86,-2.62),P<0.01;MD=-2.05,95%CI(-2.26,-1.84),P<0.01]、提高血清雌激素分别为SMD=0.69,95%CI(0.21,1.17),P<0.01;SMD=0.37,95%CI(0.01,0.74),P=0.04]方面,单用调补肝肾法可能优于常规治疗;在临床症状疗效有效率分别为RR=1.03,95%CI(0.90,1.17),P=0.68;RR=1.24,95%CI(0.94,1.63),P=0.13]、提高腰椎骨密度分别为MD=0.01,95%CI(-0.03,0.05),P=0.65;MD=0.03,95%CI(-0.01,0.07),P=0.12]指标方面,与常规治疗组相比,无显著性差异。无纳入文献提示单用或联合应用以调补肝肾为治法选用的中成药和汤剂出现不良反应。结论中成药和汤剂在改善肝肾阴虚PMOP患者腰脊疼痛、腰膝酸软无力等的症状及提高血清雌激素方面,具有一定的治疗作用,具有较好的安全性。

Meta analysis on the treatment of postmenopausal osteoporosis with traditional Chinese medicine based on regulating liver and kidney

Objective To provide evidence of the effect of traditional Chinese medicine (TCM) on postmenopausal osteoporosis (PMOP), based on theory of yin deficiency of the liver and kidney. Methods Literature of randomized controlled clinical trials on the effect of TCM based on method of regulating liver and kidney in treatment of PMOP was retrieved from CNKI, China biomedical database, Chinese Science and Technique Journals Database, Wan Fang database, the Cochrane Library, PubMed, and EMBASE. The retrieval time was from database establishment to September 2019. System evaluation and meta-analysis were performed with a RevMan 5.3 software. Results Nine references were included, including a total of 9 researches. Compared with conventional therapy with Chinese patent medicine or western medicine, the treatment based on theory of regulating liver and kidney reduced TCM syndrome score (MD=-3.74, 95%CI -4.86, -2.62, P<0.01; MD=-2.05, 95%CI -2.26, -1.84, P<0.01) and improved serum estrogen (SMD=0.69, 95%CI 0.21, 1.17, P<0.01; SMD=0.37, 95%CI 0.01, 0.74, P=0.04). The clinical efficiency of the use of regulating the liver and kidney method was better than conventional treatment (RR=1.03, 95% CI 0.90, 1.17, P=0.68; RR=1.24, 95% CI 0.94, 1.63, P=0.13). Compared with the conventional treatment group, the difference was not statistically significant in improving bone mineral density of lumbar spine and biochemical indicators in blood. There was no adverse reactions in included studies using TCM based treatment alone or combination treatment. Conclusion Chinese patent medicine and decoction based on the theory of regulating liver and kidney have certain therapeutic effect on relieving the symptoms of pain and weakness of waist and spinal, improving serum level of estrogen in PMOP patients with yin deficiency of the liver and kidney, with good security.